Pituitary gland diseases are, in general, accompanied by an impaired quality of life (QoL). Hypopituitarism is associated with macroadenomas, and QoL is lessened even if there is optimal endocrine replacement. Because most studies of QoL have included both functioning and nonfunctioning tumors, the present study aimed to assess QoL in adults whose nonfunctioning pituitary macroadenomas (NFMAs) were removed by transsphenoidal surgery. The 99 participants, who were in remission following surgery for NFMA and, in some instances, radiotherapy, and whose age averaged 62 years, were compared with 125 age-matched control patients from this and other studies. The four validated health-related questionnaires used were the Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Index (MFI), Nottingham Health Profile (NHP), and Short Form-36 (SF-36). The mean postoperative follow-up was nearly 10 years.
All but six of the 99 study patients were pituitary-deficient in at least one axis, and almost half had panhypopituitarism of the anterior pituitary. QoL was impaired in the NFMA group compared with control subjects. All elements of the MFI, which evaluates energy/fatigue, were affected, as were a majority of functions assessed by the NHP and SF-36, which assess general health and well-being. Study patients did less well than controls on all subscales of the HADS. Compared with age-adjusted reference values, deficits were found in social functioning, physical problems, emotional problems, perceived general health, lack of energy, and emotional reactivity. Stepwise univariate linear regression analysis showed age to be an independent predictor of reduced physical ability. The presence of multiple hormonal deficiencies independently predicted role limitations due to physical problems, impaired social functioning, sleep problems, and increased general fatigue. Gonadotropin deficiency predicted increased physical fatigue and reduced activity. Neither radiotherapy nor visual field defects were independent predictors of reduced QoL.
Even patients with NFMA who are successfully treated tend to have a considerably impaired quality of life. In the present study, multiple pituitary deficiencies were the strongest predictor of reduced QoL.
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
J Clin Endocrinol Metab 2006;91:3364–3369